Abstract
Malignant biliary obstruction may be caused by cholangiocarcinoma and other nonbiliary carcinomas. At the time of diagnosis, 90% of patients with malignant obstructive jaundice may benefit from palliative treatment only. The objective of palliation is to relieve jaundice-related symptoms, prevent cholangitis, prolong survival, and improve quality of life. Percutaneous transhepatic biliary stenting is a well-established procedure used in patients with malignant obstruction of intra- and extrahepatic bile ducts. Twelve patients (9 women, 3 men; mean age, 68 years; range, 44-88 years) with inoperable malignant biliary obstruction were selected for percutaneous transhepatic biliary stenting with metallic stents in the period from January to December 2007. Technical and clinical success rate in this patient series was 83% and 80%, respectively. Minor and major complications occurred in 17% and 8% of cases, respectively, which is in the range reported by the others. This is our first experience of percutaneous transhepatic biliary stenting at the Hospital of Kaunas University of Medicine and, to our knowledge, the first reported patient series in Lithuania. These first results encourage expanding effective palliation by the employment of the percutaneous transhepatic biliary stenting in patients with nonresectable malignant biliary obstruction or in case of a recurrent disease after curative surgery. The cost effectiveness of percutaneous transhepatic biliary stenting against percutaneous transhepatic biliary drainage has yet to be evaluated in a prospective manner. However, immediate clinical benefits and positive short-term outcomes are unequivocal.
Highlights
The incidence of biliary obstruction resulting from malignancies is increasing [1]
Malignant biliary obstruction may be caused by primary biliary carcinomas, and nonbiliary carcinomas [2,3,4,5,6]
At the time of diagnosis, 90% of patients with malignant obstruction of bile ducts may benefit from palliative treatment only and have a very poor prognosis [3, 7]
Summary
The incidence of biliary obstruction resulting from malignancies is increasing [1]. Malignant biliary obstruction may be caused by primary biliary carcinomas (cholangiocarcinoma, gallbladder cancer invading the liver and/or hepatoduodenal ligament), and nonbiliary carcinomas (ampullary tumors, pancreatic, advanced gastric malignancies, periportal adenopathy in the hepatoduodenal ligament, hepatocellular carcinoma, or liver metastases) [2,3,4,5,6]. Untreated biliary obstruction may lead to hyperbilirubinemia, pruritus, anorexia, cholangitis, septicemia, and liver failure. At the time of diagnosis, 90% of patients with malignant obstruction of bile ducts may benefit from palliative treatment only and have a very poor prognosis [3, 7]. The objective of palliation is to relieve biliary obstruction-related symptoms, prevent cholangitis, prolong survival, and to improve quality of life [1, 8]
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